Geriatric nursing: geriatric nursing is the
speciality that concerns itself with the
provision of nursing services to geriatric or
It is defined as the specialized nursing care
of the older adults that occurs in any setting
in which nurse use, knowledge, expertise
and caring abilities o promote optimal
AGING: aging is defined as a maturational
process that creates the need for individual
adaptation because of physical and
psychological declines that occurs during life
Chronological Age: refers to the number
of years a person has lived. Easy to
identify & measure, it is most commonly
used objective method.
Physiological Age: refers to the
determination of age by body function.
Although age related changes affect every
one, it is impossible to pinpoint exactly
when these changes occur. That is why
physiological age is not useful in
determining a person’s age.
Functional Age: refers to a person’s ability
to contribute to society and benefits others &
himself. It is based on the fact that not all
individuals of the same chronological age
function at the same level.
ANA STANDARDS OF GERONTOLOGICAL
NURSING PRACTICE (NURSING CARE)
STANDARD I. Assessment:
The gerontological nurse collects patient
STANDARD II. Diagnosis:
The gerontological nurse analyzes the
assessment data in determining diagnoses
STANDAR III. Outcome identification:
The gerontological nurse identifies
expected outcomes individualize to the
STANDARD IV. Planning:
develops a plan of cares that prescribes
interventions to attain outcomes.
STANDARD V. Implementations:
implements the interventions identified in the
plan of care.
STANDARD VI. Evaluation:
evaluates the older adults progress towards
attainment of expected outcomes.
ANA STANDARDS OF GERONTOLOGICAL
NURSING PRACTICE (QUALITY CARE)
STANDARD I. Quality of Care:
The gerontological systemically evaluates
the quality of care and effectiveness of
STANDARD II. Performance Appraisal:
The gerontological nurse evaluates his/her
own nursing practice in relation to
professional practice standards and relevant
statutes and regulations
STANDAR III. Education:
The gerontological nurse acquires and
maintains current knowledge in nursing practice.
STANDARD IV. Collegiality:
contributes to professional development of
peers, colleagues and others.
STANDARD V. Ethics:
decisions and actions on behalf of older adults
are determined in an ethical manner.
STANDARD VI. Collaboration:
collaborates with older adult, the older adults
caregiver, and all member of interdisciplinary
team to provide comprehensive care.
13. STANDARD VII. Research:
interprets applies and evaluates research
findings to improved gerontological nursing
STANDARD VIII. Resource Utilization:
considers the factors related to safety,
effectiveness and cost in planning and
delivering patient care.
PRINCIPLES OF GERONTOLOGICAL NURSING
Aging is a natural process common to all
Various factors influence the aging process.
Unique data and knowledge are used in
applying the nursing process to the older
The elderly share similar self-care and
human needs with all other human beings.
Gerontological nursing strives to help older
adults achieve optimum levels of physical,
psychological, social and spiritual and
spiritual health so that the can achieve
THEORIES OF AGING
Biological Theories of Aging-Biological
theories attempt to explain physical aging as
an involuntary process, which eventually
leads to cumulative changes in cells, tissues
Intrinsic Biological Theory-Intrinsic
biological theory maintains that aging
changes arise from internal, predetermined
Extrinsic Biological Theory-Extrinsic
biological theory maintains that
environmental factors lead to structural
alterations, which, in turn, cause
FREE RADICAL THEORY
Free-radical theory emphasizes the mechanism
of oxygen use at the cellular level. Free-radicals
are molecule with an extra cellular charge. This
charge creates a reaction that alters the
structure or function of the cell membrane.
Increased unstable free-radicals produces effect
harmful to biological systems, such as
chromosomal changes, pigment accumulation
and collagen alteration
CROSS- LINKED THEORY
The cross-link theory and connective tissue
theory asserts that the molecules of collagen
and elastin, connective tissue components,
from bonds that increase cell rigidity. Crosslinkage is thought to results from chemical
reaction that creates chemical bonds
between normally separate molecules in the
the immune system is responsible for aging.
An aging immune system is less able to
distinguish body cells from foreign cells; as a
result, it begins to attack and destroy body
cells as if they were foreign. Erratic cellular
mechanisms are thought to attack on body
tissues through auto aggression or
Error Theory: Error theory focus on the
phenomenon of decreased bonding of
protein cells that occurs spontaneously or in
response to stressors such as radiation. This
stressors results in errors in the synthesis of
RNA and DNA and produces cells with
Wear-and-Tear Theory: Body cells,
structures and functions wear out or are over
used through exposure to internal and
external stressors. Effects from the residual
damage accumulate, the body can so longer
resist stress and death occurs. Repeated
injury or overuse; internal and external
stressors, including trauma, chemicals and
build up of naturally occurring waste.
Somatic Mutation Theory: This theory
suggests that cells exposed to chemicals or
radiation results in alteration within the DNA
molecule. Mutation results from these
alterations accumulate overtime and become
more evident with age and increasing cellular
DNA Damage Theories: Aging is caused by
accumulated damage to DNA, which in turn
inhibits cells ability to function and express
the appropriate genes. This lead to cell death
and overall aging of the organism
Programmed Cellular Aging Theory: Suggest
that aging may be result of an impairment of the
cells in translating necessary RNAs as a result
of increased turnoffs of DNA. In other words, the
transcription of these messages into functional
protein may be restricted in older people. Some
segments of DNA become depleted with
advancing age, or selected cellular structures
seem to change with so that DNA transcription
Psychosocial Theories of Aging:
Psychosocial theories of aging attempt to
explain age – related changes in cognitive
function, such as intelligence, memory,
learning and problem – solving
Disengagement Theory: This theory
formulated by Cummings and Henry states
that aging people withdraw from customary
roles and engage in more introspective, selffocused activities. This theory includes 4
Aging person and society mutually withdraw
from each other.
Disengagement is biologically and
psychologically intrinsic and inevitable.
Disengagement is considered necessary for
Disengagement is beneficial for older adults
Continuity Theory: The continuity or
developmental theory states that personality
remains the same and behaviour become
more predictable as people age. This theory
focuses more personality and individual
behaviour over time.
Activity Theory: Successful aging and life
satisfaction depend on maintaining high level
of activity. According to this perspective, the
maintenance of optimal physical, mental and
social activity is necessary for successful
aging this theory also assumes that older
adults have the same needs as middle-age
Adjustment Theory: Adjustment theory
defines aging as a series of adjustment to
retirement, to grandparenthood, to change in
income, to changes in social life and marital
status and to potential deterioration of health
and well being.
Autoimmune theory: proposes that
decrease in immune function may result in
an increase in autoimmune response
causing the body to produce antibodies that
ASSESSMENT OF OLDER ADULTS
1. FUNCTIONAL ASSESSEMENT
Katz Index: It is for activities of daily living is
widely used for evaluating a patient’s ability
to perform daily personal self care activities.
This tool ranks the patient’s ability to
perform six function: Bathing, Dressing,
Toileting, Continence and Feeding
Barthel index: This type of tools helps to
assess a patient’s capacity for self care. It
evaluates 10 items: Feeding, Moving from
wheel chair to bed and returning, Getting on
and off the toilet, Walking on a level surface
or propelling a wheel chair, going up and
down stairs, dressing and under dressing,
maintaining bowel incontinence and
Lawton Scale: This is used for instrumental
activities of daily living. This tool evaluates
the patient’s ability to perform more complex
personal care activities needs to support
independent living, such as ability to use the
telephone, shop, do laundry, manage
finance, take medications and prepare
OARS Social Resources Scale: The Older
Americans Research Service Center[OARS]
social resources scale is a multidimensional
assessment tool developed at Duke
University in 1978. It evaluates level of
function in 5 areas: Social recourses,
Economic resources, Physical health, Mental
health and Activities of daily living.
AGE RELATED BODY SYSTEM CHANGES
Decreased muscle mass, size and
muscle look smaller.
Decreased in muscle tone.
Decreased amount of elastic tissue.
Slower muscle response.
Decrease in elasticity of tendons & ligaments.
Decreased range – of – motion – stiffness.
Decreased joint mobility.
Osteoporosis – thinning and softening of the
Exaggerated bony prominence.
Shortening of height as result of
intervertebral space narrowing caused by
Synovial fluid becomes more viscous.
Increased collagen formation, which cause
loss of resilience & elasticity in joints.
Increased dryness of skin.
Thinning in the layer of the skin.
Increased pigmentation, causing liver/ aging
Decreased elasticity of skin, causing
Decreased subcutaneous fat layer of skin.
Facial lines around the eye, mouth and nose.
Hardness & dryness of nail, making them
Decrease in nail growth rate & strength.
Toenails may discolour.
Thinning of scalp hair.
Decrease in melanin, which result in gray
Hormonal changes cause pubic hair loss.
Increased growth of nose, ear & facial hair.
Slight growth of hair on upper lip & chin in
Decreased sebaceous & sweat glands, which
has implications for dryness & decreased
Slowed heart rate.
Reduced ability of the heart to quickly
increases its rate in response to an
emergency because of thickening of heart
valves, left ventricle and aorta.
Decreased stroke volume & cardiac
Decreased elasticity of blood vessels.
Increased rigidity & thickening of valves.
More irregular heart beats, arrhythmias, which
leads to poor oxygenation of the heart.
Increased blood pressure – 140/90 – 160/100.
Increased peripheral vascular resistance.
More visible superficial blood vessels of legs.
Common diastolic murmur.
Weaken pedal pulse & colder lower extremities.
Nose enlargement from continued cartilage
Increased antero – posterior diameter.
Increased chest rigidity.
Increased respiratory rate with decreased
Decreased diffusion capacity of the lungs.
Decreased total pulmonary surface area for
Decreased inspiratory & expiratory muscle
strength diminishes vital capacity.
Increased size of alveoli.
Increased airway resistance.
Decrease in lung’s elastic recoil capability.
Dilation of bronchioles & ducts.
Weaker cough or gag reflex,
Decreased depth of respiration & oxygen
Decreased saliva production, increased
Changes in taste and smell.
Decreased gag reflex.
Decreased motility, peristalsis in stomach.
Decreased production of GI secretions –
Delayed gastric emptying.
No functional changes in small intestine.
Decreased tone in bowel wall & anal
Alterations in bowel habits – constipation.
Decreased liver weight & Decreased blood
Marked decline in liver enzymes which
affects drug metabolism and detoxification.
Decreased kidney size, function & output.
Decreased golmerular filtration.
Reduced renal blood flow from decreased
Decreased efficiency of kidney to
Diminished kidney filtration rate & tubular
function, which cause a decrease in the
renal clearance of drugs.
Decreased number of nephrons.
Decreased bladder size and tone.
Incomplete bladder emptying & chronic
urine retention from weakness of bladder
Increased ease of backflow of urine.
Decreased bladder capacity.
Increased residual urine frequency &
Increased incidence of UTIs.
Increased plasma urea & uric acid.
Decreased pancreatic insulin release & peripheral
Decreased glucose tolerance with advancing age.
Alteration in hormone production.
Decreased secretion of estrogen, FSH & LH
Decreased secretion of progesterone &
Decreased production of rennin, angiotensin, &
Decreased secretion of aldosterone contributes to
decreased sodium reabsorption
Decreased secretion of ADH contributes to
decreased water reabsorption.
Decreased secretion of thymosin & thyroxin.
Progressive loss of brain cells.
Decreased blood flow & oxygen utilization
Increased size of ventricles and thinning of
Decreased number of neurons,
neurotransmitters & nerve conduction.
Increased length of dendrities & number of
Decreased reflex with increased nerve
Decreased ability of the hypothalamus to
regulate body temp.
Decreased sense of balance or equilibrium.
Decrease sensitivity & sensation.
Irregular sleep stages.
Decreased motor coordination response.
Eye and vision
Decreased visual acquity.
Eyelids loss their elasticity.
Conjunctiva become thinner& yellow.
Quantity of tears decreases.
Decreased pupil size & speed of adjusting to
change in light.
Decreased ciliary muscle efficiency.
Decreased accommodation due to impaired
Lens enlarges and loses transparency.
Impaired colour vision.
Sclera becomes thick & rigid and fat deposits
Diminished night vision and depth of
Ears and Hearing
Decreased elasticity of eardrum.
Diminished hearing acquity.
Decreased ability to hear high- pitched
Gradual cerumen accumulation.
Slowly progressive deafness- prebycusis or
Decreased taste perception.
Reduction in number of functioning taste
Decreased amount of saliva.
Decreased sense of smell.
Decreased number of olifactory neurons.
Decreased deep sensation.
Decreased vibratory sense & pain
Decreased temperature regulation.
Decreased immune response.
Decreased antibody response make them
more susceptible to infection.
Decreased number & function of T-cells.
Male reproductive system
Decreased testosterone production cause
Decrease size and firmness of testes.
Prostate gland enlarges and secretion decreases.
Seminal fluid decreases in volume& less viscous.
Decreased intensity of sensation.
Decreased speed of erection & force of
Decreased sperm count.
Female reproductive system
Decreased vaginal lubrication, dry, pale, and less elastic.
Thinning & shortening of vaginal wall.
Vaginal acidity reduced.
Decreased size of labia and clitoris.
Decreased quantity of pubic hair.
Ovaries atrophy and become thinner & smaller.
Uterus becomes smaller and less firm.
Decreased secretion of estrogen, progesterone, FSH& LH
Cessation of menses after menopause.
Breasts become pendulous.
Nipples decrease in size and become flat.
Glandular, supporting & fatty tissue atrophy.
Degenerative changes in the gonads lead to abrupt cessation
of the menses
COGNATIVE CHANGES OF NORMAL AGING
Factors affects cognition
Sensory changes and disease associated
Pain from chronic disease
Medications side effects
Changes in mental functioning
range of interests, and understanding.
Increased repetitive thoughts and
vulnerability to stress.
Changes in memory
Short –term memory, which is associated with
decreased judgement, insight, and orientation.
Gradual memory loss
Learning and intelligence
Aging may affect learning.
Hesitancy in answering questions or repeating
Intelligence does not declines as on age.
PSYCHOSOCIAL ASPECTS OF AGING
DEPRESSION AND SUICIDE
COMMON MEDICAL PROBLEMS IN OLD AGE
Prevention of pressure ulcers
Monitor the pressure areas by measuring
length, width and depth of to gauge of the
Turn the patient ever two hours
Keep the patient skin clean and dry
Place the pillow between the pressure areas
to prevent friction and pressure
Teach the active and passive exercises
Use paper tape to secure dressing
Promote normal bowel elimination.
Remove faecal impactions.
Palpate patients abdomen and auscultate
for bowel sounds
Monitor the patent use of laxative and
Watch for anxiety
Speak to the patient slowly in a soft and
Assess the patients needs for assistance.
Give the patient plenty of time to complete
Provide small frequent feeding
Assess the patient ability to swallow
Obtain current weight and weight history of
Assess signs for hypoglycaemia
Monitor intake and out put
Administer intravenous insulin
Administer intravenous fluid
Explain all the procedure to the patient
Assess the signs and symptoms of pain.
Apply ice pack to the joint
Teach the patient about active and passive
Encourage the patient to avoid walking
Teach the patient to organize the activities
of daily living.
MEDICATION IN ELDERLY
Major problems with prescriptive medication
include adverse effect, medication
intervention, medication errors, non
compliance and cost.
Determine the use over the counter
Medication dosage normally as prescribed at
one third to one half of normal adult dose.
Closely monitor client for adverse effect&
response to therapy because the increased
risk for medication toxicity.
Note that a common sign of an adverse
effect in the older client is an acute change in
Asses for medication interaction in the client
taking multiple medication.
Advise the client to use one pharmacy &
notify the consulting physician of the
Administration of medication
Place the client in a sitting position when
administering medication taken.
Check for mouth dryness because
medication may stick & dissolve the mouth.
Administer liquid preparation if the client has
difficulty in swallowing.
Crush tablets if necessary & give with
textured food, if not contraindicated.
Do not crush –entric- coated tablets& do not
Do not crush –entric- coated tablets& do
not open capsules.
If administering a suppository do not insert
suppository immediately after removing
A suppository may take longer time to
dissolve because decreased body core
When administering parentral medication,
monitor the site it may ozze medication or
bleed because of decreased tissue
Do not use an immobile limb for administering
Monitor client compliance with taking prescribed
Monitor client for safety in correctly taking
medications including an assessment of their
ability to read the instructions & discriminate
among the pills& their colour & shape.
Use medication cassette to facilitate proper
administration of medication.
ABUSE OF THE OLDER ADULTS
Abuse involves physical emotional or sexual
abuse & also can involve neglect or
Categories of mistreatment
STRESS AND COPING IN ELDERLY
Common stressors of old age include:
Normal aging changes that impair physical
function, activities and appearance.
Disabilities and chronic illness.
social and environment losses of income,
roles and activities.
Death or illness of significant others.
Physical and sexual abuse.
Depression, heavy drinking, or insufficient
Social issues, such as social defeat, or
Some suggestions may help to reduce the stress
Take one think at a time.
Visualization – imagination hoe you can manage a
Meditation – 5-10 min of meditation can bring
Be flexible and clam
Adopt healthy life style
Share feelings with family members or friends.
USE OF AIDS AND PROSTHESIS
PROSTHESIS: Prosthesis is an artificial
device used to replace a missing body part
such as a limb, tooth, eye or heart valve.
Prosthesis refers to the replacement of the
missing body part with such a device. In
medicine, prosthesis is an artificial extension
that replaces a missing body part.
DENTAL PROSTHESIS: is an artificial
appliance which is used as a substitution for
the replacement of teeth. In certain
conditions of missing teeth empty space
between teeth can lead to teeth shifts to
compensate for the space.
Mastication: chewing ability is improved by
replacing edentulous areas with denture teeth.
Aesthestics: the presence of teeth provide a
natural facial appearance, and wearing a denture
to replace missing teeth provides support for the
lips and cheeks and corrects the collapsed
appearance that occur after losing the teeth.
Phonetics: by replacing missing teeth, especially
the anteriors patients are better able to speak by
improving pronunciation of those words containing
siblints or fricatives.
Self esteem: patients feel better about
A hearing aid is an electroacoustic body worn
apparatus which typically fits in or behind the
wearer’s ear and is designated to amplify
and modulate sound for the wearer. Earlier
devices, known as an “ear trumpet’ or “ear
TYPES OF HEARING AIDS
BEHIND THE EAR(BTE)
IN THE EAR(ITE)
IN THE CANAL, (ITC)MINI CANAL ( MIC),
COMPLETELY IN THE CANAL(CIC)
BONE CONDUCTION HEARING AIDS
Care and maintenance of hearing aids
Prevent it from falling down
Don’t spill liquids on the hearing aids
The hearing aids should be fitted well
Cords should not be twisted or knotted
Protect it from dust, dirt &heat
Remove the battery from hearing aids
when it is not in use
The receiver should not come in contact
Gather medical, family and psychological history
Perform patient assessment
Explain diagnosis and treatment to the patient and family
Work closely with patient, family, and other health care
professionals to develop a good nursing care plan suitable for
Foster elderly patients independence
Provide medication and treatments and evaluate responses
Maintain hydration, nutrition, aeration and evaluate response
Administer emergency treatment when necessary
Initiate discharge planning & coordinate referral to community
Serve as patient advocate
Inform doctor of any change patient condition
Long Term care
Gather medical, family, and psychological history
Perform patient assessment
Involve patient and family preparation and implementation
of nursing plans.
Promote the atmosphere that emphasises quality living,
not diseases and dying.
Ensure that patient receives, medical, dental and eye
Maintain hydration, nutrition, aeration comfort of elderly.
Provide medications, treatments, rehabilitative exercises
and evaluate responses.
Treat and advice patient and family.
Become knowledgeable person and refer the patient and
family to appropriate sections.
Perform emergency measures when necessary.
Inform doctor of change of patients condition.
Identify health, social, or economic needs
Refer elderly person to professional or other
agencies, to suit their needs.
Explain diagnosis and treatment to patient and family
Evaluate compliance with response to treatments
Use clinics and home visits for health promotion
Teach and advise patient and family
Evaluate elderly persons ability to live independently
Become advocate for elderly persons
Encourage elderly person to become advocate on his
SPECIAL CONSIDERATIONS IN CARE OF ELDERLY
Promotion of self respect and dignity
Promotion of comfort
Daily living activities
Promotion of independence
Promotion of movement and mobility
Use of meditation in elderly
COMMUNITY AND INSTITUTIONAL HEALTH CARE
HOME CARE: home care is a range of
health & supportive services provided in the
home for people who require assistance in
meeting their health care needs. These
agencies may be governmental, private or
HOSPICE CARE: A hospice is a resources
for the terminally ill. A hospice can be
independent unit within the community that
provides support to the client & family in the
home or it may be contained within an
institution. The programme focused on
meeting the needs of the dying patient and
RESPITE CARE: Respite care provides
caregiver relief for a brief, time – limited
period. It can be offered in the home, through
a day care program or within a facility or
institution. An advantage in the home, is that
the patient is familiar with physical
DAY CARE: Day care provides an alternative
to institutionalization. Offering health &
rehabilitative services. Day care center
clients are usually not seriously ill, although
they may have chronic conditions or
disabilities that limit independence. These
individuals cannot be left alone during the
day when family members are at work or
SENIOR CENTERS: Senior centers offer a
variety of social, health, and nutritional ,
educational and recreational services. They
give older people the opportunity to gather
for social activity. Besides being meting
places, senior center offers councelling,
special trips, legal services & advice on
CHECK – IN SERVICE: Some senior
centers, churches and other community
agencies offer telephone check – in services,
in which a volunteer phone a client at a
certain time each day to ascertain his status
& to provide social contact.
LONG TERM CARE: It refers to a
continuum of services, including medical
care, nursing care & personnel or
psychological services. Long term care
services provide care for people at varying
levels of dependence who will require care
for an extended period.
EMERGENCY RESPONSE SYSTEM : ERS
provide a link between the elder living alone
& emergency services. The ERS when
activated can dispatch police an ambulance
or other appropriate services to the
individuals home. ERS alarm may warn as
jewellery, may be attached to the telephone
or may be placed next to the bed or
Social isolation related to inadequate
Health seeking behaviours related to home
safety measures that prevents falls
Impaired home maintence management
related to inadequate social support system
Actively listen to the client
Give positive reinforcement
Helps the client to explore the causes of
Assist the client to develop a plan of action
Assess the client’s home for safety hazards
Explore the health status of all family
Arrange for additional support for care givers
Risk for impaired ski integrity related to urinary
Assess the perineal area for signs of skin
Change the continence pad immediately after
an episode of urinary incontinence
Provide proper perineal care.
Apply a moisture cream barrier to the perineal
Instruct the female patient to avoid using
feminine hygiene products
Self – care deficit related to increased
forgetfulness secondary to disease
Assess patient need for assistance
Give the patient plenty of time to complete
Maintain or ensure physical activity as
tolerated and range of motion exercise to